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Death rate steady with pediatric early warning system


Key clinical point: Use of a pediatric early warning system (BedsidePEWS) did not reduce rates of all-cause hospital mortality among hospitalized children, compared with usual care, but did reduce rates of significant clinical deterioration events.

Major finding: For hospitals implementing BedsidePEWS, all-cause hospital mortality was 1.93 per 1,000 patient discharges, versus 1.56 per 1,000 at hospitals with usual care (adjusted odds ratio, 1.01; 95% confidence interval, 0.61-1.69; P = .96).

Study details: A multicenter cluster randomized trial of 144,539 patient discharges from 21 hospitals in seven countries providing pediatric care.

Disclosures: The Canadian Institutes of Health Research funded the study. Dr. Parshuram is an inventor of BedsidePEWS and owns shares in a company that is commercializing it.

Source: Parshuram et al. JAMA. 2018 Feb 27. doi: 10.1001/jama.2018.0948.



Use of a pediatric early warning system reduced the incidence of late ICU admissions among hospitalized pediatric patients, but did not reduce the rate of all-cause hospital mortality, according to results of a large, multicenter trial.

Taken together, the findings of the trial do not support the use of the Bedside Pediatric Early Warning System (BedsidePEWS) to reduce hospital mortality, noted investigator Christopher S. Parshuram, MBChB, DPhil, during a presentation at the Critical Care Congress sponsored by the Society of Critical Care Medicine.

A child is shown in a hospital bed, along with an IV drip ©drpnncpp/
BedsidePEWS is a documentation-based care system that combines a validated severity of illness score, a specialized documentation record, and specific recommendations for care escalation.

The multicenter randomized cluster study, called the EPOCH trial, included 21 hospitals in seven countries that provided inpatient pediatric care. Ten of the hospitals delivered the BedsidePEWS intervention, while the remaining 11 provided usual care. The study data included 144,539 patient discharges comprising 559,443 patient days. Enrollment began Feb. 28, 2011, and ended on June 21, 2015.

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